广东省儿童肺功能检查应用现状及质量控制调查分析

Investigation and analysis of the application status and quality control of pulmonary function testing in children in Guangdong Province

目的了解广东省儿童肺功能检查应用现状及质量控制情况。方法对2020年5月1日至11月30日申请广东省哮喘标准化门诊建设的71家医院提交已开展的各项儿童肺功能检查项目及报告质量控制情况进行分析。结果71家医院中三甲医院31家(43.66%);非三甲医院40家(56.33%)。区域分布:珠三角地区50家(70.42%),粤北地区10家(14.08%),粤西地区7家(9.86%),粤东地区4家(5.63%)。肺功能仪配备中以常规肺通气功能仪(100.00%),潮气呼吸肺功能仪(63.38%)为主,非三甲医院脉冲振荡及呼出气一氧化氮仪低于三甲医院(P<0.05),开展项目中常规肺通气检测以及潮气肺功能检测最为常见,非三甲医院支气管舒张试验、脉冲振荡以及呼出气一氧化氮开展率明显低于三甲医院(P<0.05)。收到322份常规肺通气功能报告,其中三甲医院148份,非三甲174份。三甲医院及非三甲医院质控一级报告分别为124份(83.78%)和108份(62.07),二级分别为6份(4.06%)和23份(13.22%),五级分别为18份(12.16%)和41份(23.57%)。三甲医院一级报告比例明显高于非三甲医院,二级和五级报告比例低于三甲医院(P<0.05)。结论广东省三甲医院儿童肺功能检查开展情况优于非三甲医院;肺功能仪配备更好;检查项目更多。区域发展不平衡,珠三角地区应用情况优于粤东、粤西及粤北地区。肺功能报告质量控制中三甲医院优于非三甲医院。因此儿童肺功能检查有待进一步推广、普及,对其临床应用的认识及报告质量控制有待进一步加强,需要开展系统化、规范化培训,使肺功能检查更好地服务于临床诊疗工作。

Objective To investigate the application status and quality control of pulmonary function testing in children in Guangdong Province.Methods A total of 71 hospitals applied for the construction of standardized asthma outpatient service between May 1,2020 and Nov.30,2020,and they submitted reports on the pulmonary function testing items for children,whose quality control was analyzed.Results Among the 71 hospitals,31(43.66%)were Grade Ⅲ Level A,and 40(56.33%)were not.There were 50(70.42%)in the Pearl River Delta,10(14.08%)in north Guangdong,7(9.86%)in west Guangdong and 4(5.63%)in east Guangdong.Among the equipment for pulmonary function testing,spirometer(100%)and tidal breathing pulmonary function instrument(63.83%)were the most common;in the non-Grade Ⅲ Level A hospitals there were fewer impulse oscillometers and exhaled nitric oxide equipment(P<0.05).Among the testing items,routine pulmonary ventilation detection and tidal pulmonary function determination were the most common.The rate of performing bronchodilation testing,impulse oscillometer and exhaled nitric oxide detection in the non-Grade Ⅲ Level A hospitals was lower than that in Grade Ⅲ Level A hospitals(P<0.05).Totally 322 reports on routine pulmonary ventilation were received,of which 148 were from the non-Grade Ⅲ Level A hospitals,174 were not.There were 124(83.78%)first-class quality control reports from Grade Ⅲ Level A hospitals and 108(62.07%)from non-Grade Ⅲ hospitals,6(4.06%)and 23(13.22%)second-class reports and 18(12.16%)and 41(23.57%)fifth-class reports,respectively.The proportion of first-class reports was higher in Grade Ⅲ hospitals than in non-Grade Ⅲ hospitals,while the proportion of second-class and fifth-class reports was lower(P<0.05).Conclusion The application status of pulmonary function testing for children in Grade Ⅲ Level A hospitals of Guangdong Province is better than that in non-Grade Ⅲ hospitals:the instruments are better and there are more testing items.There is deference among different regions:the Pearl River Delta is better than the north,west and east Guangdong.As for quality control of reports,the Grade Ⅲ hospitals are better than the non-Grade Ⅲ hospitals.Therefore,the pulmonary function testing needs to be further popularized,and the clinical application and quality control of reports should be strengthened.Systemized and standardized training is required to enable pulmonary function testing to better serve clinical diagnosis and treatment.